References of "Acta Chirurgica Belgica"
     in
Bookmark and Share    
Full Text
Peer Reviewed
See detailGuidelines for quality improvement in cardiac surgery. The College of Cardiac Surgery : results of the 2007 survey.
De Smet, J. M.; Kolh, Philippe ULg; Van Kerrebroeck, Chr et al

in Acta Chirurgica Belgica (2008), 108(6), 638-44

Optimal delivery of health care is a common goal of individual physicians, professional organizations, hospital structures and governmental authorities. A growing concern has emerged from the public ... [more ▼]

Optimal delivery of health care is a common goal of individual physicians, professional organizations, hospital structures and governmental authorities. A growing concern has emerged from the public, media and third payer organizations concerning the quality of care and the amount of resources spending. In the United States, large databases, guidelines and performance evaluation have been elaborated by medical societies, particularly in the area of cardiac surgery. These tools are useful for improvement of patients' care, resources distribution, pay for performance and public and practitioners' awareness. The evaluation of quality is based on composite models combining structure, process and outcome indices. However, pitfalls such as patients' selection, and risk avoidance in order to improve results must been prevented by adjustment of the treated populations' risk factors by specific scores. The Belgian Health authorities have built a structure directed at delivery of care improvement based on "Care Programs", monitored by Colleges formed by delegates of professional organizations. The College of Cardiac Surgery has promoted several studies aimed at data collection and evaluation. In 2007, a survey was addressed to all the Belgian Cardiac surgeons to define their opinion as to the best indicators of care in their specialty. These results will serve to define further avenues of research. By maintaining the responsibility of care evaluation in the hands of the involved professionals, this kind of cooperation between governmental and physicians' organizations seems to serve the best interests of the public and the practitioners. [less ▲]

Detailed reference viewed: 92 (0 ULg)
Full Text
Peer Reviewed
See detailHealth care cost containment.
Van Damme, Hendrik ULg; Michel, L.

in Acta Chirurgica Belgica (2008), 108(1), 2-3

Detailed reference viewed: 13 (4 ULg)
Full Text
Peer Reviewed
See detailExtended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases.
Durieux, Rodolphe ULg; Radermecker, Marc ULg; Dekoster, Guy ULg et al

in Acta Chirurgica Belgica (2008), 108(1), 102-6

BACKGROUND: Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the ... [more ▼]

BACKGROUND: Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. METHODS: A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. RESULTS: The mean age of the patients at surgery was 34 years (range, 9-63) and 78.9% were female. Mean length of follow up was 86 months (range, 24-163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5-23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol and Mestinon decreased significantly between the pre-operative period and the last follow-up (Medrol, p = 0.0081; Mestinon, p = 0.0013). CONCLUSIONS: Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time. [less ▲]

Detailed reference viewed: 53 (4 ULg)
Full Text
Peer Reviewed
See detailImmunosuppression in Pancreas Transplantation The Euro SPK Trials and Beyond
Malaise, J.; De Roover, Arnaud ULg; Squifflet, Jean-Paul ULg et al

in Acta Chirurgica Belgica (2008), 108

The Immunosuppression in Pancreas Transplantation was historically based on the fact that the pancreas is an extremely immunogenic organ. Quadruple drug therapy with polyclonal or monoclonal antibodies ... [more ▼]

The Immunosuppression in Pancreas Transplantation was historically based on the fact that the pancreas is an extremely immunogenic organ. Quadruple drug therapy with polyclonal or monoclonal antibodies induction was the mainstay therapy since the introduction of Cyclosporine A. In the modern era of Immunosuppression, Mycophenolate Mofetil replaced Azathioprine while Tacrolimus-another potent calcineurin inhibitor-had-and still has-a difficult challenge to replaced Cyclosporine A, due to its potential diabetogenic effect. Thanks to the first two EuroSPK studies which prospectively tried to answer several questions in that field. But, the future challenge will be in understanding the impact of innate immunity and ischemic reperfusion injuries on the long term graft function. Hopefully, new drugs will be available and tested to block unspecific deleterious reactions to attenuate the proinflammatory response. It will be the aim of the third Euro SPK Stud [less ▲]

Detailed reference viewed: 60 (3 ULg)
Full Text
Peer Reviewed
See detailCurrent concepts in breast reconstruction
Preud'homme, L.; LEMAIRE, Vincent ULg; Nizet, Jean-Luc ULg

in Acta Chirurgica Belgica (2008), 108(3), 298-303

As the incidence of breast cancer increases, breast reconstruction is more and more often proposed and its indications are viewed in terms of quality of life. In the past, delayed reconstruction was the ... [more ▼]

As the incidence of breast cancer increases, breast reconstruction is more and more often proposed and its indications are viewed in terms of quality of life. In the past, delayed reconstruction was the rule. Progress in reconstructive techniques currently allows performing immediate reconstruction in selected cases, even when the operative field has to be irradiated. These new techniques generally improve the result of breast reconstruction. Moreover, expansion of screening techniques allows detection of small tumors for which a conservative excision is sufficient. Nevertheless, this kind of less aggressive surgery may require a reconstructive procedure in order to maximise the aesthetic result. [less ▲]

Detailed reference viewed: 14 (3 ULg)
Full Text
Peer Reviewed
See detailOpen surgery for abdominal aortic aneurysm or aorto-iliac occlusive disease--clinical and ultrasonographic long-term results.
Fontaine, Robert ULg; Kolh, Philippe ULg; Creemers, Etienne ULg et al

in Acta Chirurgica Belgica (2008), 108(4), 393-9

OBJECTIVE: To determine postoperative and long-term outcome and assess the relevance of abdominal ultrasound (US) after surgery for abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD ... [more ▼]

OBJECTIVE: To determine postoperative and long-term outcome and assess the relevance of abdominal ultrasound (US) after surgery for abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD). METHODS: Records of 1704 consecutive patients having graft implantation from 1988 to 2000, either for AAA (n = 1144) or for AIOD (n = 560), were reviewed. In 2006, follow-up was 9180 patients-years for the AAA group and 5450 patients-years for the AIOD group. Among 1006 alive patients, 377 were invited randomly for US and clinical examination. RESULTS: Hospital death occurred in 99 patients (8.6%) of the AAA group (53% in ruptured and 2% in elective AAA), and in 18 patients of the AIOD group (3.2%). There were 581 late deaths, including eight due to prosthesis infection, one to pseudo-aneurysm rupture, and one to graft thrombosis (0.6% graft-related mortality). Prosthesis thrombosis occurred in 32 patients (26 in AIOD group, p < 0.001), and graft infection in 26 (17 in AAA group, p < 0.01). Pseudoaneurysms developed in 90 patients (68 in AIOD group, p < 0.001), including eight at the proximal aortic, one at the distal aortic, two at the iliac and 79 at the femoral anastomosis. In the AAA group only, surgery was required for a new thoraco-abdominal and pararenal aneurysm in eight and four patients, respectively, while US evidenced a 26-35 and a 36-50 mm supraanastomotic aortic dilatation in 65 (32%) and in 14 (7%) patients, at a mean follow-up of 10.5 and 9.3 years, respectively. CONCLUSION: Long-term results are good after open surgery for AAA or AIOD. Prosthesis infection and anastomotic pseudo-aneurysm are the main causes of graft-related mortality and morbidity, respectively. Because of high incidence of asymptomatic supraanastomotic aortic dilatation, all patients with a history of AAA repair should have regular abdominal US. [less ▲]

Detailed reference viewed: 128 (4 ULg)
Full Text
Peer Reviewed
See detailDescription and Evaluation of a Simplified Technique for Replacement of the Ascending Aorta and Proximal Arch in Degenerative Aneurysmal Disease
Radermecker, M. A.; Nasser, A.; Fontaine, R et al

in Acta Chirurgica Belgica (2007), 107(6), 733-8

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of ... [more ▼]

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation. [less ▲]

Detailed reference viewed: 20 (6 ULg)
Full Text
Peer Reviewed
See detailDiagnosis and treatment of peripheral arterial disease: recommendations for the medical practice in Belgium.
Clement, Denis; Kolh, Philippe ULg; Motte, Serge et al

in Acta Chirurgica Belgica (2007), 107(6), 595-604

Detailed reference viewed: 62 (1 ULg)
Full Text
Peer Reviewed
See detailCatamenial Pneumothorax: A Case Report and Review of the Literature
Pappalardo, E.; LAUNGANI, Alexis ULg; DURIEUX, Rodolphe ULg et al

in Acta Chirurgica Belgica (2007), 107(6, Nov-Dec), 695-6

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but ... [more ▼]

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence. [less ▲]

Detailed reference viewed: 20 (0 ULg)
Full Text
Peer Reviewed
See detailIntra-arterial thrombolysis of thrombosed popliteal artery aneurysm. A series of six cases
Van Damme, Hendrik ULg; Trotteur, Geneviève ULg; Kerzmann, Arnaud ULg et al

in Acta Chirurgica Belgica (2006), 106(6), 679-683

Aim of the study : To evaluate the role of perioperative, catheter-guided fibrinolysis in the management of thrombosed popliteal artery aneurysms. Material : From 1990 to 2005, six patients suffering ... [more ▼]

Aim of the study : To evaluate the role of perioperative, catheter-guided fibrinolysis in the management of thrombosed popliteal artery aneurysms. Material : From 1990 to 2005, six patients suffering subacute limb ischemia, secondary to thrombosis of a popliteal artery aneurysm, benefited selective intra-arterial fibrinolysis, followed by subsequent aneurysm exclusion and bypass grafting. This represents ten percent of all popliteal aneurysms operated on in that time period and 28% of all thrombosed popliteal artery aneurysms. Results : The lytic procedure was successful in all cases, restituting patency in two (n = 3), one (n = 2) or all (n = 1) crural arteries. The venous bypass graft remained patent in all but one patient. In one patient, the graft occluded at 10 months without limb loss. This outcome compares more favorable than the result obtained with emergent surgery alone for thrombosed popliteal artery aneurysms with profound limb ischemia (eight patients, of whom one required amputation at day 5 and one lost his limb at nine months following graft thrombosis). Conclusion : Preoperative intra-arterial lytic therapy, in the setting of subacute limb ischemia caused by thrombosis of a popliteal artery aneurysm, can be considered as safe and effective. [less ▲]

Detailed reference viewed: 53 (0 ULg)
Full Text
Peer Reviewed
See detailImpact of 2D and 3D vision on performance of novice subjects using da Vinci robotic system
Blavier, Adelaïde ULg; Gaudissart, Quentin; Cadière, Guy-Bernard et al

in Acta Chirurgica Belgica (2006), 106(6), 662-664

Purpose of the study : The aim of this study was to evaluate the impact of 3D and 2D vision on performance of novice subjects using da Vinci robotic system. Methods : 224 nurses without any surgical ... [more ▼]

Purpose of the study : The aim of this study was to evaluate the impact of 3D and 2D vision on performance of novice subjects using da Vinci robotic system. Methods : 224 nurses without any surgical experience were divided into two groups and executed a motor task with the robotic system in 2D for one group and with the robotic system in 3D for the other group. Time to perform the task was recorded. Results : Our data showed significant better time performance in 3D view (24.67 +/- 11.2) than in 2D view (40.26 +/- 17.49, P < 0.001). Conclusions : Our findings emphasized the advantage of 3D vision over 2D view in performing surgical task, encouraging the development of efficient and less expensive 3D systems in order to improve the accuracy of surgical gesture, the resident training and the operating time. [less ▲]

Detailed reference viewed: 319 (7 ULg)
Full Text
Peer Reviewed
See detailSurgical treatment of thoraco-abdominal and low thoracic aneurysms of the aorta. One single center experience over ten years
El Arid, J.-M.; CREEMERS, Etienne ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2006), 106(6), 669-674

This work presents the results of surgery in thoraco-abdominal aortic aneurysms (TAA) and thoracic descending aortic aneurysms (TDA) in one single center between January 1rst, 1996 and December 31, 2005 ... [more ▼]

This work presents the results of surgery in thoraco-abdominal aortic aneurysms (TAA) and thoracic descending aortic aneurysms (TDA) in one single center between January 1rst, 1996 and December 31, 2005. It concerns open surgery in 42 and endovascular procedures in ten patients. Forty two patients (11 TDA and 31 TAA (4 type I, 12 type II, 6 type III and 9 type IV)) define the open surgery series. Twenty six patients were operated on elective basis and 16 patients in emergency condition. Surgical correction was made under partial cardio-pulmonary bypass (PCPB) in 70% of cases via femoral vessels; most significant intercostal arteries were reimplanted and cerebro-spinal fluid (CSF) drainage used in half of the cases. Operative mortality was zero in the elective group (0/26) and attained 19% in the emergent group (3/16). Mortality was linked to cerebrovascular accidents (CVA) in two cases and post-pump left lung hemorrhagic intarction in one case. The paraplegia accounts 2/26 in the elective group and one in the emergent group (1/16). That is 7.1% in both groups. At the end of five years, survival is 66% in elective group and 74% in the emergency group. Ten patients (5 TDA and 5 TAA (2 type I, 3 type III)) were treated endovascularly. Operative mortality and postoperative paraplegia were nil. [less ▲]

Detailed reference viewed: 18 (1 ULg)
Full Text
Peer Reviewed
See detailLessons learnt from carotid artery trials
Van Damme, Hendrik ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2006), 106(5), 489-499

The objective of the authors is to assess the natural history of carotid artery disease and the role of carotid intervention in preventing ipsilateral stroke. The development of endovascular techniques ... [more ▼]

The objective of the authors is to assess the natural history of carotid artery disease and the role of carotid intervention in preventing ipsilateral stroke. The development of endovascular techniques for correction of carotid artery stenoses made this less invasive technique very popular, with an inherent risk of unregulated overuse by a variety of medical specialists, who are not always well informed on the natural history of carotid artery disease. It re-opened the discussion on the value of carotid endarterectomy for stroke prophylaxis. This ongoing debate offers the opportunity to distil evidence-based guidelines for the management of extracranial carotid artery stenoses. In recent papers, some authors expressed doubts on the validity and general applicability of the results of the pivotal randomised trials of carotid endarterectomy. The excellent results in terms of operative outcome and long term stroke prevention would, according to certain comments, not be attainable in routine practice. Another criticism of carotid endarterectomy is its higher operative morbidity in terms of cranial nerve lesions and myocardial infarctions, compared to endovascular procedures. This consideration is, for some authors, the main reason to espouse carotid artery stenting as a better alternative to carotid endarterectomy. Any evidence supporting this point of view is missing. The supposed equivalence or non-inferiority of carotid artery stenting is purely speculative. The aim of this review paper is to summarize the crude data of carotid surgery trials. The authors aim to answer four questions. For which lesions is carotid endarterectomy most beneficial ? Are the results of randomised carotid surgery trials biased by the selection of patients ? Is operative morbidity, other than stroke, under-estimated ? Is carotid artery stenting safe and efficacious ? An in-depth review with a critical analysis is made of recently published and on-going trials, comparing carotid surgery with percutaneous carotid angioplasty. [less ▲]

Detailed reference viewed: 7 (0 ULg)
Full Text
Peer Reviewed
See detailLaryngeal dysfunction after thyroid surgery: diagnostic and treatments
FINCK, Camille ULg

in Acta Chirurgica Belgica (2006), 106

Vocal fold hypomobility after thyroidectomy is a frequent complication of thyroidectomy. Laryngeal nerve paresis or paralysis may present with various symptoms like dysphagia, aspiration, voice alteration ... [more ▼]

Vocal fold hypomobility after thyroidectomy is a frequent complication of thyroidectomy. Laryngeal nerve paresis or paralysis may present with various symptoms like dysphagia, aspiration, voice alteration or dyspnea. Are described: the normal anatomophysiology of the larynx, the symptoms of nerve trauma following thyroidectomy, techniques of thoroughfull laryngeal and voice examination, some clinical entities( unilateral recurrent nerve paralysis, bilateral recurrent nerve paralysis, superior laryngeal nerve paralysis),natural evolution of paralysis, prognosis and management of laryngeal paralysis) [less ▲]

Detailed reference viewed: 47 (5 ULg)
Full Text
Peer Reviewed
See detailThromboprophylaxis in microsurgery
Lecoq, Jean-Pierre ULg; Senard, Marc ULg; Hartstein, Gary ULg et al

in Acta Chirurgica Belgica (2006), 106(2), 158-64

Microsurgical free tissue transfer has become a gold standard in a wide range of clinical situations. Thrombosis at the anastomotic site is not only the most common cause of failure of microsurgical ... [more ▼]

Microsurgical free tissue transfer has become a gold standard in a wide range of clinical situations. Thrombosis at the anastomotic site is not only the most common cause of failure of microsurgical operations, but it is also one of the factors resulting in microcirculatory intravascular thrombosis in free flaps. All conditions of thrombus formation, defined by Virchow in 1856, are encountered in free flap surgery. This literature review concerns the problem of thromboprophylaxis in microsurgery. All citations published this last ten years (1996-2005) concerning this problem are noted. Data are confronted with other specialties, particularly vascular surgery, or with large retrospective studies. Protocol used in our institution is presented at the end of this lecture. [less ▲]

Detailed reference viewed: 61 (3 ULg)
Full Text
Peer Reviewed
See detailCytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Carcinomatosis : Higher Complication Rate for Oxaliplatin Compared to Mitomycin C
Rouers, A.; Laurent, S.; Detroz, Bernard ULg et al

in Acta Chirurgica Belgica (2006), 106

Peritoneal carcinomatosis (PC) from colo-rectal cancer carries a very poor prognosis with a mean and median overall survival times of 6.9 and 5.2 months. It has been proved that a locoregional therapeutic ... [more ▼]

Peritoneal carcinomatosis (PC) from colo-rectal cancer carries a very poor prognosis with a mean and median overall survival times of 6.9 and 5.2 months. It has been proved that a locoregional therapeutic approach of this disease with cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) improved survival of these patients. However, this combined treatment presents a high complication rate. Methods : 21 patients with PC of colorectal origin underwent complete cytoreduction followed by HIPEC using Mitomycin-C (13 patients) or oxaliplatin (8 patients) and the open coliseum technique. For each case the medical datas were retrospectively analysed to determine feasibility, morbidity, mortality, survival time and prognostic factors. Results : All patients presented a Sugarbaker’s Peritoneal Cancer index inferior to 15. The mean operating time was 453 minutes. After a median follow-up of 24.9 months, actuarial disease-free survival was 36.6% at 5 years. The median survival time was 34 months. The morbidity rate was 33.3% with a significant higher complication rate in the oxaliplatin group (5/8) than in the Mytomycin-C (MMC) group (2/13). One patient (4.7%) died two months after treatment with MMC (endocarditis). Conclusions : This series confirm positive impact of cytoreduction and HIPEC on PC. We obtained a moderated complications rate thanks to a high degree of selection of the patient. Oxaliplatin scheme is responsible of a higher morbidity than in MMC group. Phase III trial comparing these two drugs is needed. [less ▲]

Detailed reference viewed: 21 (3 ULg)
Full Text
Peer Reviewed
See detailWhy Did it Take so Long to Start a Non-Heart-Beating Donor Program in Belgium ?
Squifflet, Jean-Paul ULg

in Acta Chirurgica Belgica (2006), 106

The first cadaver kidney transplant, performed in June 1963 in Belgium, was from a heart beating donor (HBD). It was the first ever in the world. Since that period, almost all cadaver organs were procured ... [more ▼]

The first cadaver kidney transplant, performed in June 1963 in Belgium, was from a heart beating donor (HBD). It was the first ever in the world. Since that period, almost all cadaver organs were procured from brain death donors. When the Belgian law on organ donation and transplantation was published on February 1987, with its opting-out principle, no emphasis was placed on procuring organs after cardiac death. Based on the Maastricht experience, in the early nineties, the transplant community interpellated the National Belgian Council of Physicians to facilitate organ procurement in Non-Heart-Beating Donors (NHBD) following the law. But, the transplant community had to wait for the impulse of the first International Congress on NHBD in 1995,where the 4 categories of Maastricht NHBD were defined. It also published 12 Statements and Recommendations which were eventually approved by the European Council. Then all local Ethical Committees received queries for approving local NHBD programs. Almost all centres requested viability testing assessment of the NHBD organ prior to implantation, and proposed the introduction of machine perfusion technology. Finally, all centres joined their efforts and made a collaborative agreement with Organ Recovery Systems for a 24/7 machine perfusion service from a central laboratory. During a three year period (2003-2005), 46 NHBD kidneys were recovered. Among these kidneys, 32 were perfused in the Organ Recovery Systems central laboratory. The Delayed Graft Function (DGF) rate for these perfused kidneys was 25%. Only one graft was lost in this subgroup. Livers, pancreases (for islet preparation) and lungs (for experimental ex-vivo evaluation) were also recovered from these non-heart-beating donors. [less ▲]

Detailed reference viewed: 46 (2 ULg)
Full Text
Peer Reviewed
See detailAdjuvant hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) Associated with curative surgery for locally advanced gastric carcinoma.An initial experience
De Roover, Arnaud ULg; Detroz, Bernard ULg; Detry, Olivier ULg et al

in Acta Chirurgica Belgica (2006), 106(3), 297-301

Aim of the study : After macroscopic radical (R0) surgery for advanced gastric carcinoma, 40 to 50% of the tumors recur in the abdomen as locoregional or peritoneal disease. We initiated a protocol in ... [more ▼]

Aim of the study : After macroscopic radical (R0) surgery for advanced gastric carcinoma, 40 to 50% of the tumors recur in the abdomen as locoregional or peritoneal disease. We initiated a protocol in which patients with suspicion of macroscopic serosal, lymphatic or peritoneal invasion, treated with R0 resection, underwent adjuvant HIPEC. Methods : Between June 1998 and January 2003, 16 patients with locally advanced adenocarcinoma of the stomach were included in the study. Surgery consisted of a total gastrectomy with a D2 lymphadenectomy. Splenectomy (n = 1), splenopancreatectomy (n = 4), transverse colectomy (n = 3), left hepatectomy (n = 1), localized peritonectomy (n = 3) were associated to obtain a R0 resection. HIPEC protocol consisted of heated (42.5°C) intraperitoneal mitomycin C (15 mg/m2) for a planned duration of 90 minutes. Results : HIPEC median duration was limited to 73(20-90) min because of central hyperthermia recognition in half of the cases. One patient died in the postoperative period of sepsis secondary to a duodenal fistula. Postoperative morbidity included pancreatic fistula (n = 2), pulmonary oedema (n = 1), pulmonary embolus (n = 1) and transient renal failure (n = 1). UICC staging was IB (n = 2), II (n = 2), IIIA (n = 5), IIIB (n = 1), IV (n = 6). Nine of the 16 patients are alive without recurrence with a median follow-up of 52 months. Four patients developed a recurrence, intraperitoneal (n = 2), systemic (n = 1), or combined (n = 1). Two patients were lost to follow-up. Conclusions : Aggressive surgical therapy and HIPEC might represent the standard of care in a selected population with locoregional disease and for whom a R0 resection can be achieved. This protocol was associated in this study with a 75% 5-year survival with a low peritoneal recurrence rate and an acceptable morbidity. [less ▲]

Detailed reference viewed: 192 (7 ULg)
Full Text
Peer Reviewed
See detailPotential benefits of laparoscopic aorto-bifemoral bypass surgery
Rouers, Anthony; MEURISSE, Nicolas; LAVIGNE, Jean-Paul ULg et al

in Acta Chirurgica Belgica (2005), 105(6), 610-615

Background: This series aims to prove the positive impact of laparoscopic approach in aortofemoral bypass grafting. Methods : It concerns a retrospective non randomized study comparing 58 consecutive ... [more ▼]

Background: This series aims to prove the positive impact of laparoscopic approach in aortofemoral bypass grafting. Methods : It concerns a retrospective non randomized study comparing 58 consecutive patients treated with laparoscopic procedure (n = 30) and with a standard open procedure (n = 28) in a single center. The different operating times, the complications and the follow-up of these two groups are compared Results : The demographics and angiographic data of the two groups were comparable. Operating time was longer in the laparoscopic group. However, we noticed a significant shorter hospitalisation stay (p < 0.0001) after the laparoscopic procedure with a mean 5.1 days. There was no significant difference of morbidity. Conclusion : We suggest that the trans-peritoneal approach is the best way in laparoscopic procedure in term of exposure and ergonomics. Laparoscopic aortofemoral bypass grafting is feasible, safe and effective. Shortening of operating time is observed as surgeon's experience grows. [less ▲]

Detailed reference viewed: 69 (1 ULg)
Full Text
Peer Reviewed
See detailOutlook of non operated type B aortic dissection with special reference to the incidence of degenerative abdominal aortic aneurysm (AAA). One center study
Quaniers, Janine ULg; CREEMERS, Etienne ULg; Limet, Raymond ULg

in Acta Chirurgica Belgica (2005), 105(5), 487-490

Objectives : to determine the value of pharmacological treatment of type B aortic dissection (B AD) in face of new forms of treatment. Design : this is a retrospective study of the period from 1990 to ... [more ▼]

Objectives : to determine the value of pharmacological treatment of type B aortic dissection (B AD) in face of new forms of treatment. Design : this is a retrospective study of the period from 1990 to 2000. Files of 81 patients have been reviewed and completed by questionnaires. Results Two B AD died after admission without any treatment, 10 were operated on with 7 discharged alive (group 1) 69 received hypotensive agents and beta-blockers, 65 were discharged alive (group 11). Late mortality of the group I is 3/7, not related with B AD. Late mortality after mean follow-up of 56.8 months is 27/65 with 4/27 related to B AD (4 ruptures, 2 operated on). Non fatal secondary surgery amounts 5 in 4 patients. Total B AD aortic events comprise 8/65 patients. Type A AD were operated on successfully (8 : 4 before B AD, and 4 after B AD). Degenerative abdominal aortic aneurysms were present, operated (9) or not (3), in the history of patients and 3 more appear subsequently. At 10 years, actuarial survival is 40% +/- 18. Conclusion : in non-complicated cases of B AD, medical treatment is a reasonable choice, provided that a strict follow-up of the thoracic abdominal aorta is performed. [less ▲]

Detailed reference viewed: 35 (0 ULg)